Provider Demographics
NPI:1366455602
Name:DAVIS EYE CENTER, INC.
Entity Type:Organization
Organization Name:DAVIS EYE CENTER, INC.
Other - Org Name:FALLS OPHTHALMOLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-923-5676
Mailing Address - Street 1:789 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221
Mailing Address - Country:US
Mailing Address - Phone:330-923-5676
Mailing Address - Fax:330-923-0411
Practice Address - Street 1:789 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221
Practice Address - Country:US
Practice Address - Phone:330-923-5676
Practice Address - Fax:330-923-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3491207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0232724Medicaid
2143577OtherAETNA
CD6845OtherRAILROAD MEDICARE
=========000OtherMEDICAL MUTUAL
OH=========-00OtherWORKERS COMPENSATION
CD6845OtherRAILROAD MEDICARE
OH9282171Medicare ID - Type Unspecified
CD6845OtherRAILROAD MEDICARE